Hormone related suicide risk in midlife women going undetected
Around 1 in 6 (16.6%) women are experiencing suicidal thoughts during perimenopause and menopause that are not being identified or treated effectively, according to new clinical research published today by Liverpool John Moores University and Newson Clinic.
With an estimated 13 million women currently perimenopausal or menopausal, researchers warn that many doctors may be missing opportunities to detect women at risk. Suicidal thoughts do not always correlate with standard depression scores, meaning many women are left without support or treatment during perimenopause and menopause, which are already associated with higher suicide rates.
The study, published in BJPsych International, analysed data from 957 perimenopausal and menopausal women at their first appointment at a specialist hormone clinic. More than 70% of women were experiencing moderate to severe low mood or emotional distress. However, researchers found that suicidal thoughts did not consistently match how depressed women appeared on standard questionnaires, suggesting that some women at risk may be reassured rather than flagged during routine assessments.
Women were also regularly prescribed antidepressants which may not work alone or at all in some cases where hormonal imbalances are at play.
These findings demonstrate that menopause and perimenopause must be recognised as critical times within national mental health and women's health policy
Pooja Saini, Professor of Suicide and Self-Harm Prevention
Pooja Saini, Professor in Suicide and Self-Harm Prevention at Liverpool John Moores University said: “Too many women are being assessed with tools that do not fully capture the hormonal drivers of suicidal thoughts, leaving gaps in care that are both avoidable and dangerous. These findings clearly demonstrate that perimenopause and menopause must be recognised as critical times within national mental health and women’s health policy.”
Suicide rates are highest in women aged 45 to 50, which is the common age for perimenopause and menopause and the research highlights the importance of individualised care with the right dose and type of hormones, based on symptoms and clinical need.
Among women who reported suicidal thoughts at the start of the study, these thoughts reduced by more than 90% after hormone treatment with progesterone, estradiol and testosterone. The largest improvements in overall mental health were observed in women using combined HRT regiments, including those that included testosterone.
Needlessly suffering
Dr Louise Newson, GP and hormone specialist at Newson Clinic, said: “Mental health symptoms of low mood, anxiety and intrusive thoughts are very common during perimenopause and menopause. More women experience suicidal thoughts than has been realised before, and many women are needlessly suffering.
“We are hearing these stories more and more, and there is a real concern that missed opportunities for hormone treatments are leaving women unsupported with their lives at risk when the consequences can be devastating.”
Researchers said the findings underline the need for greater awareness of perimenopause and menopause as a critical period for mental wellbeing, and for more training about the association of mental health and hormones as well as safe prescribing of hormone treatments.
Professor Saini added: “There is now an urgent need for integrated clinical pathways, improved training for healthcare professionals, and consistent access to evidence‑based hormone treatments across the NHS. Policymakers and health systems must respond to this evidence to ensure that women are not left without the support they need at a time when timely intervention could be life saving.”
